Friday, August 18, 2017

Strong Community Health Centers Benefit All Of Us

Why Do Those With Insurance Get to Decide Who Gets Care?

For 51 years community health centers (CHC) have delivered care to the underserved and the job is not getting easier. Regardless of your political affiliation, you should celebrate the movement of routine medical care from our nation’s emergency rooms to community health centers. You can argue against a national health plan, but in reality, the use of emergency rooms for the delivery of primary care is a national health plan.

Perhaps one of the most significant flaws of the Obama Administration was their national rhetoric. The Affordable Care Act (ACA) (Obamacare) did so much more than mandate insurance coverage. The ACA significantly expanded the CHC network and revenues. States with Medicaid expansion saw substantially more insured patients than those who opted not to expand Medicaid. In 2015, 1,375 health centers delivered care to 24.3 million people including 1 in 6 Medicaid patients. Yet, the debate about the future of Obamacare remains centered on mandated insurance.

Additionally, the ACA set up a federal grant fund, that is essential to the existence of CHCs. In 2015, this trust fund provided 20% of the funding to these centers and allowed them to deliver care to those that are without any insurance or assistance.

Congress, in an amazing bipartisan action, extended the ACA, health center trust fund until September 30, 2107. But, what happens then???

The discourse in America now about the future of the ACA fails to look beyond the surface to the progress made toward a more cost effective delivery of healthcare to the underserved.

I meet and work for so many physicians and administrators who work exceptionally long hours, for very little pay, to ensure that our most underserved have a chance. There is no question that the delivery of routine care dramatically reduces the number of emergency room visits or length of hospital stays. The providers who work in what we call “mission-minded medicine” do so because of the size of their heart, not the size of their paycheck.

They must not be left to soldier on alone.

Luckily for most of you reading this, and certainly for our elected officials, we have insurance coverage. We don’t need to find our nearest community health center.  

I am not advocating for more assistance or for a national health plan, yet all we seem able to do is argue about our difference. We desperately need incentives to encourage physicians to work in our CHCs, because they certainly are not compensated adequately. We struggle to find doctors willing to work in rural or urban community centers because they are unable to pay their insurance and student debt.

Because of the laws regarding federally underserved areas, we funnel our foreign trained physicians in need of a J1 Visa Waiver to these communities, but we offer no incentives for them to remain in these areas once their waiver obligation is met. Resulting in communities with no continuity of care and the added expense and disruption of hiring a new provider every three years.

This year as we celebrate the 51 years of community medicine, stop and take a stand. Consider that the care must be delivered somewhere and someone must pay for it. Demand that your elected officials stop arguing about the inane and instead focus on: incentives for physicians to serve this community, incentives for physicians to choose primary care careers, and the extension and expansion of the funding needed to continue community medicine.

Whatever your political affiliation, we all benefit from a strong community health center system. And many, many thanks to the men and woman who serve on the front lines. We all owe you a debt.  


Tuesday, February 21, 2017

Physicians Continue to Choose New Delivery Care Options

As I have watched the crescendo of noise and news around the repeal and replace of ACA over the last weeks, I found myself hoping that the baby does not get thrown out with the bathwater. Last week, I found myself at my local urgent care/stand-alone ER. I can choose from three within a mile or two. I choose this center because it is a hybrid offering both urgent care and ER services and it is open 24 hours. I also like the young ER doc who is usually there.

Like 70% of primary care practices, my PCP does not offer after hours care and currently it takes about five days to get a sick appointment in her practice. I have learned a lot about healthcare delivery from my doctor friend. He left his job at a large ER to participate in this experiment to offer urgent care and ER care in a single facility. He gets to control the balance of his life, spend one on one time with patients and take a stand in how he delivers medicine.  

This center is a part of “The ER Savings Initiative, a movement to educate and inform consumers, employers, and governments about the excessive and unnecessary utilization of the emergency room. The Hybrid Community Care bills patients as urgent care or emergency care based on the level of service needed thereby saving millions locally in unnecessary charges with better outcomes.”

Personally, this seems like a brilliant concept to me. Entering the facility as an urgent care patient and being treated as such, usually meets all our needs. On a couple of occasions, after some tests and a long discussion with the physician, a decision was made to move to ER services. This choice came with a clear discussion of the reason, signatures on multiple forms, explanation of the additional cost and an actual physical move to a different treatment room.

Not only was this exceptionally convenient, but it allowed me to go home in much better condition than would have occurred without the ER option. Every employee in the facility is a part of a team and is willing to function in any necessary role and to do so with a great attitude and smile. Procedures are performed promptly and efficiently without hours spent waiting.

Keeping the facility staffed is sometimes a juggling act and the physician in charge directs the patient flow. The tech who started my IV told me that the “acuity level” of care he delivers is not as high as it was at the hospital ER, but he likes the doctors, the patients and the way he is treated. The facility is always staffed with an ER doctor as well as a support team. Urgent care centers often allow physicians much more control over their schedule.

Over and over candidates are making choices which allow them to retain control over their lives. In a survey in 2016, The Inline Group found that 44% of graduating residents list “quality of life” as their number one job factor. Of the primary care candidates surveyed, 70% list location as their first consideration when making a job change.

The ACA has changed the delivery model of healthcare in America. Physicians have more choices today about where they want to practice and given the choice they continue to choose work-life balance. The exponential growth of urgent care centers and innovative options will continue to entice physicians interested in treating patients in more non-traditional settings.


Chris Mathew, COO of The Inline Group, and I will be attending and speaking at the Urgent Care Association of America Urgent Care Convention and Expo later this year and learning even more about the trends taking place in urgent care. If you'd like to know more about what we're seeing in staffing urgent care centers, contact us and we'll be happy to share our data.